Canada has done such a good job of blunting its first wave of COVID-19 infections it’s very much in danger to being susceptible to a second, third and even fourth wave of outbreaks, according to Dr. James Downar, a specialist in critical care, palliative care and medical ethics.

“The wave doesn’t even have to be that big to overwhelm us. If one per cent of Canadians got COVID-19 at any given time, which doesn’t seem like a lot, we would be grossly overwhelmed, like not even close,” Downar said in an interview.

Downar, who’s on the front lines in Ottawa treating critically ill COVID-19 patients, wrote the triage protocol for Ontario hospitals about who gets scarce ventilators. It’s not yet a published document, but what’s known about the triage road map is that patients aren’t excluded by age, but on how likely they are to survive if put on a ventilator.

These are measures that haven’t been needed yet, but Downar says it’s premature to declare victory. “We weren’t good, we were lucky – like, you have to write that 50 times,” he said.

Some U.S. hospitals became overwhelmed because they were hit early with a large wave of infections, and yet the U.S. has twice as many ventilators per capita as Canada.

According to Downar, Canadian hospitals still need more ventilators along the tubing and medications that go with them and staff to operate them, in order to stave off being swamped by the inevitable next wave of infections.

“The likelihood of it happening in the next couple of weeks is low. The likelihood of it happening after that is as high as it’s ever been.”

The success of the lockdown and social distancing has meant that 99 per cent of the Canadian population is uninfected and susceptible to a second viral wave that could become a flood.

“I’m not being a doomsdayer here, quite the contrary. And I’m also not being critical of the decisions made. They were the right decisions.”

The alternative – a Darwinian culling in order to develop herd immunity – would have been disastrous. “According to the models if the first wave had proceeded without the social distancing measures we would have run out of ventilators between April 7 and April 14,” Downar said.

It’s not sustainable to keep people locked up and the economy shut down for a year and a half or so until a vaccine is developed. In the meantime, how to safely return to state of near normal?

Downar suggests looking at the Scandinavian model and what he calls a “manageable controlled burn” – protecting the old and the vulnerable, but letting children return to school and transmit the virus to healthy adults until enough of the population is protected that a new virus outbreak can’t take hold.

In contrast, in the U.S.,there seems to be a series of bonfires igniting along political party lines, with restaurants opening Monday in Tennessee in a Republican state, and barbershops, hair salons, tattoo parlours and bowling alleys opening last week in Georgia. As Jeffrey Shaman, an epidemiologist at Columbia University told the Washington Post Sunday, “We’re flying blind,”

Canada is proceeding more cautiously. Despite Quebec Premier François Legault’s plan to start opening schools in outlying areas, the federal government is feeling its way more slowly, announcing late last week a COVID-19 Immunity Task Force that will, among other goals, look into implementing “medical and social measure to mitigate the rapid spread of COVID-19.”

During his press conference Saturday, Prime Minister Justin Trudeau made it clear this does not mean handing out so-called immunity passports to people who’ve already caught the virus and recovered.

“It is very clear the science is not decided on whether or not having COVID-19 once prevents you from getting it again,” he told reporters.

Canada’s chief public health officer, Dr. Theresa Tam agreed Saturday the level of immunity among Canadians is possibly “quite low.” However, she said the idea of generating natural immunity – opening up and letting people freely circulate – is “not something that should be undertaken.”

It’s the beginning of an exploratory process, with no answers yet, “We did not buy a reprieve from [COVID-19], we bought time and whether we used it well or not remains to be seen ,” Downar said.